Biomedical subjects
Publications and source records attributed to D Altman.
An endodeoxyribonuclease, designated CreI, was purified 16,000-fold from zygotes of the eukaryote Chlamydomonas reinhardtii. CreI preferentially attacks the sequence TATA producing double strand breaks with 3'-phosphomonoester and 5'-hydroxyl termini. The endonuclease has an Mr = 27,000 and requires Ca2+ at pH 7.5 for optimal activity.
The Avionics Pressurometer III is the only noninvasive indirect ambulatory blood pressure system which provides 24-h blood pressure measurements, but it has been subjected to limited evaluation. We report a critical evaluation comparing it to simultaneous intra-arterial blood pressures both at home and at hospital as well as during standardized exercise. Comparisons with simultaneous indirect methods were also made. Twenty-two hypertensives undergoing intra-arterial ambulatory blood pressure monitoring wore the two recorders for one day. The mean difference (standard deviation SD) for intra-arterial blood pressure--Avionics blood pressure was 2 (SD 8.6)/-14 (SD 10.3) mmHg at home and -3 (SD 15.4)/-11 (SD 12.3) mmHg at hospital. At the end of exercise the figures for the same comparison were -7 (SD 16)/0 (SD 15.6) mmHg. In general the agreement between intra-arterial and Avionics pressurometer recordings was closer for systolic than for diastolic blood pressures but there was wide variation for individuals as shown by the standard deviations about the mean difference. We did not use the recorder at night as patients complained that the noise kept them awake and so night-time blood pressures were not attainable. We do not think the recorder performed satisfactorily during physical exertion, and in view of its expense, this recorder is of limited potential value in supplying accurate information.
High response rates have been reported with hepatic intra-arterial infusions of floxuridine in patients having colorectal carcinoma metastatic to the liver. The major toxicity of this therapy has been described as "chemical hepatitis." In a randomized trial of intravenous v intra-arterial floxuridine, we observed that all 35 patients receiving intra-arterial therapy developed significant increases in alkaline phosphatase and, in some cases, serum glutamic oxaloacetic transminase and/or bilirubin. Seven patients receiving intra-arterial therapy were studied with cholangiography which, in all cases, demonstrated sclerosis of the intrahepatic and/or extrahepatic bile ducts. In addition, liver biopsies showed cholestasis and pericholangitis with minimal hepatocyte damage. These findings suggest that "biliary sclerosis" rather than "chemical hepatitis" is the predominant toxicity associated with hepatic intra-arterial infusions of floxuridine.
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This study explored the usefulness of archival data in predicting rural health care utilization. A regression model was used to see how well observed utilization for local populations could be predicted by calculating expected values in advance from age- and sex-specific national rates applied to local age and sex profiles. Although the correlation between observed and expected utilization was reasonably high (r = 0.92), an attempt was then made to improve prediction by considering other data that do not require independent collection. These archival data included indicators of historic utilization (local Medicaid payments, the percentage of births to county residents occurring in the mother's county of residence, percentage of children immunized, and infant mortality) and services already available. Observed utilization data were obtained by surveys in eight rural counties, and the predictor was tested on three additional rural communities. A predictor equation that added to the expected utilization only one variable (the percentage of births to county residents occurring in the mother's county of residence) was found to account for approximately 95% of the variance in observed utilization. This predictor is recommended for planners who need convenient, low-cost market feasibility estimates for proposed project sites and a way to establish intermediate goals or incentives during early project development.
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1 The hypotensive action of labetalol was evaluated during 24 h by continuous intra-arterial ambulatory monitoring in 14 patients. The dose used ranged from 300--1800 mg daily. 2 The drug caused a significant reduction of systolic BP in 19 and diastolic BP in 20 of the 24 h of monitoring. Heart rate was also reduced but less markedly than BP. 3 The rapid early morning increase in BP was also effectively controlled. 4 The mild pre-waking increase in BP was not significantly reduced. 5 Labetalol treatment reduced the variation in systolic BP from the lowest observed quarter-hourly mean as compared with pre-treatment values. 6 The quarter hourly mean values were consistently smooth and revealed no sudden variations which might have resulted from postural hypotension.
This paper examines the political and bureautic dynamics of health regulation under the National Health Planning and Resources Development Act and, to a lesser extent, the Carter Cost Proposal now before Congress. A number of underlying issues that affect the day-to-day exercise of health planning are considered, including the contest between state and local and federal government for program control, jurisdictional conflict between state and local planning agencies, and the unsettled roles to be played by professional planners, consumers, and providers. When we assess regulatory policy in health, these complicating factors must be added to the long list of handicaps that already exist. One important finding is that local planning agencies have embraced the task of health regulation somewhat more fully than had generally been expected. A number of explanations for this are offered. In short, the controlling factors in health planning are political, not technical, and there is more occurring at the state and local levels than many had predicted, although any impact is not likely to be dramatic.
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MR was performed on six patients clinically diagnosed as having neurofibromatosis. Owing to its multiplanar capability, MR greatly helped determine the extent of visual pathway disease. We attempted to find specific optimal pulse sequences for evaluating the prechiasmatic, chiasmatic, and retrochiasmatic visual system at 0.35 T. Using spin-echo techniques, we evaluated a T1-weighted sequence (TR 300 msec/TE 35 msec), an intermediate T2-weighted sequence (TR 1500 msec/TE 35 msec), and a T2-weighted sequence (TR 1500 msec/TR 70 msec). We found that the orbital and intracanalicular optic nerves were most accurately and easily seen with the T1-weighted sequence axially and coronally; the chiasm was best seen with the intermediate T2-weighted coronal sequence; and the retrochiasmatic visual pathway was optimally evaluated with T2-weighted spin-echo technique.
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